The Compliance Guy

On this episode of TCG - The #TerryTuesday episode Karen N. George of Buchalter Law Firm joins Sean and Terry Fletcher to discuss payer contracting and all the ins and outs to ensure success! 

Such a great episode! 

About Karen N. George:

Karen George is an attorney at Buchalter in the Los Angeles office and is a member of firm’s Health Care Practice group. Karen specializes in managed care contracting and routinely represents healthcare providers in large exposure reimbursement disputes and litigation against payors. Karen regularly handles out-of-network reimbursement disputes, coverage disputes, coordination of benefits issues, and recoupment demands. Karen represents a diverse array of healthcare providers, including hospital systems, physician groups, ambulatory surgery centers, urgent care centers, outpatient clinics, billing companies, and telehealth companies. Karen has resolved significant disputes with payors, recovering millions of dollars for providers in civil actions and arbitrations. Karen received a bachelor’s degree in Psychology and Criminology from the University of California, Irvine and earned her law degree from Georgetown University of Law Center.

On this episode Terry Fletcher, Scott Kraft and Paul Spencer join Sean for their Monday Coding and Compliance Roundtable to discuss Cloning and Clinical Plagiarism and who is actually accountable for compliance within an organization. 

This was a live stream with great audience participation and outstanding interaction between the panelists!  

Alice Harris and Jenna Godlewski of Nexsen Pruet - Health Law Team join Sean to discuss The 2022 Strategic Plan also known as the "CMS Framework. The ladies identify Six Trends to Follow for the remainder of 2022 and well beyond, but they only scratched the surface! Here is the link to their article: Understanding the CMS 2022 Strategic Plan:  Six Trends to Follow (nexsenpruet.com) The Six Trends focused on during our discussion include:

Medicare and Medicaid Beneficiaries Will Be Moved to ACO Contractors by 2030

Providers Will Be Subject to More Pre-Authorization Processes

Nursing Home Staffing Will Continue to Be Scrutinized

Expect Avalanche of New and Revised CMS Regulations

CMS’ Efforts to Ensure Prescription Drug Accessibility Will Include Increasing Use of Generics, Biosimilars, and Interchangeable Biologics

Expect CMS to Vastly Improve Access to Behavioral Health Services

This was a brilliant conversation you are not going to want to miss! 

*There is an audio glitch in the very beginning as one of our guest's microphones was having some issues. We did the best we could to clean it up and think it turned out pretty okay! 

Thank you for making us a Top 25 Podcast: https://blog.feedspot.com/regulatory_compliance_podcasts/

The Compliance Guy has been Nominated in 2 categories (Andy Curry Award and The Business Category) for a People's Choice Award. The voting has now opened and if you would, please vote for The Compliance Guy Podcast in the 2 Categories mentioned above! Simply go to this link: https://lnkd.in/grYHk-8P and register then it will take you to the nominations page for you to vote... Once you click on the "Andy Curry" and "Business" categories and you will find "The Compliance Guy" half way down... Click on it, then submit and you are done!

In this episode Sean takes on Modifier 25 and all the problems that comes with it. Critical explanations for how to properly define the modifier (significant and separately identifiable), NCCI Edit changes for 2022, OIG Report on Modifier 25, and how CMS and other payers are scrutinizing your claims! 

Thank you for making us a Top 25 Podcast: https://blog.feedspot.com/regulatory_compliance_podcasts/

The Compliance Guy has been Nominated in 2 categories (Andy Curry Award and The Business Category) for a People's Choice Award. The voting has now opened and if you would, please vote for The Compliance Guy Podcast in the 2 Categories mentioned above! Simply go to this link: https://lnkd.in/grYHk-8P and register then it will take you to the nominations page for you to vote... Once you click on the "Andy Curry" and "Business" categories and you will find "The Compliance Guy" half way down... Click on it, then submit and you are done!

In this episode Terry joins Sean to discuss Transitional Care Management and Chronic Care Management and all of the auditing, billing, coding, and compliance information you need to get it right! 

These are not profit centers, at least how they are structured so be careful and avoid the pitfalls associated with these services! 

Thank you for making us a Top 25 Podcast: https://blog.feedspot.com/regulatory_compliance_podcasts/

The Compliance Guy has been Nominated in 2 categories (Andy Curry Award and The Business Category) for a People's Choice Award. The voting has now opened and if you would, please vote for The Compliance Guy Podcast in the 2 Categories mentioned above! Simply go to this link: https://lnkd.in/grYHk-8P and register then it will take you to the nominations page for you to vote... Once you click on the "Andy Curry" and "Business" categories and you will find "The Compliance Guy" half way down... Click on it, then submit and you are done!

On this episode Terry A Fletcher BS CPC CEMC CCC CCS CCSP CMC ACS-CA SCP-CA, QMPM, Scott Kraft, Stephanie Allard, CPC, CEMA, RHIT Christine Hall CHC CPC , CPB, CPMA, CRC, CEMC, CPC-I and John Paul Spencer join Sean live to discuss a variety of coding and compliance issues being uncovered in their daily auditing, coding and compliance activities on behalf of clients all across the United States! 

Today's Topics Include: 

1. Required OIG Compliance - Making sure you are in lockstep with the government

2. The Impact of Corrective Action Plans following a potential violation and how to ensure it's being adhered to

3. Preoperative visits billing for #emservices for the pre-op clearance in the same group that the surgeon/physician is a part of. 

4. Laboratory services performed by critical access #hospitals for out-of-state providers leading to compliance #risks, and sometimes hospital closure

Don't miss this one! 

Thank you for making us a Top 25 Podcast: https://blog.feedspot.com/regulatory_compliance_podcasts/

The Compliance Guy has been Nominated in 2 categories (Andy Curry Award and The Business Category) for a People's Choice Award. The voting has now opened and if you would, please vote for The Compliance Guy Podcast in the 2 Categories mentioned above! Simply go to this link: https://lnkd.in/grYHk-8P and register then it will take you to the nominations page for you to vote... Once you click on the "Andy Curry" and "Business" categories and you will find "The Compliance Guy" half way down... Click on it, then submit and you are done!

In this episode Sean sits down with Maggie Perritt - Medicare Compliance Officer for Mass Advantage (MA Plan) to discuss her role as a compliance officer for the plan, prior authorization, claims processing, claims adjudication, engagement with law enforcement and so much more! 

Was a great discussion you will not want to miss! 

Thank you for making us a Top 25 Podcast: https://blog.feedspot.com/regulatory_compliance_podcasts/

The Compliance Guy has been Nominated in 2 categories (Andy Curry Award and The Business Category) for a People's Choice Award. The voting has now opened and if you would, please vote for The Compliance Guy Podcast in the 2 Categories mentioned above! Simply go to this link: https://lnkd.in/grYHk-8P and register then it will take you to the nominations page for you to vote... Once you click on the "Andy Curry" and "Business" categories and you will find "The Compliance Guy" half way down... Click on it, then submit and you are done!

In this 20 minute episode Sean covers specific sections of the Medicare Program Integrity Manual (Chapter 3) as it relates to the Medicare Medical Record Review Standards and Requirements for MACs, RACs, UPICs, SMRCs, and CERTs... Don't miss this one especially if you are responsible for the appeals and adjudication of claims! 

Thank you for making us a Top 25 Podcast: https://blog.feedspot.com/regulatory_compliance_podcasts/

The Compliance Guy has been Nominated in 2 categories (Andy Curry Award and The Business Category) for a People's Choice Award. The voting has now opened and if you would, please vote for The Compliance Guy Podcast in the 2 Categories mentioned above! Simply go to this link: https://lnkd.in/grYHk-8P and register then it will take you to the nominations page for you to vote... Once you click on the "Andy Curry" and "Business" categories and you will find "The Compliance Guy" half way down... Click on it, then submit and you are done!

Telehealth is the number 1 audit target for commercial and government payors. Whether it's originating site, place of services, interactive v audio only, requirements for documentation, etc. providers all over the country are struggling. Give us less than 50 minutes and we will make it all make sense! 

Thank you for making us a Top 25 Podcast: https://blog.feedspot.com/regulatory_compliance_podcasts/

The Compliance Guy has been Nominated in 2 categories (Andy Curry Award and The Business Category) for a People's Choice Award. The voting has now opened and if you would, please vote for The Compliance Guy Podcast in the 2 Categories mentioned above! Simply go to this link: https://lnkd.in/grYHk-8P and register then it will take you to the nominations page for you to vote... Once you click on the "Andy Curry" and "Business" categories and you will find "The Compliance Guy" half way down... Click on it, then submit and you are done!

This Monday round table discussion was outstanding, with an amazing panel! I was joined by Christine Hall CHC CPC , CPB, CPMA, CRC, CEMC, CPC-I Terry A Fletcher BS CPC CEMC CCC CCS CCSP CMC ACS-CA SCP-CA, QMPM John Paul Spencer, COC, CPC and Scott Kraft, CPMA, CPC!

We focused on the most pressing auditing billing compliance and coding challenges! Don't miss this outstanding panel discussion and remember, bring your questions and let our #smes sort out the complexities for you.

Footnote: Unfortunately Christine Hall lost power and had to join via iPad in the middle of a horrible storm in Florida so please excuse the issues with her volume. 

Thank you for making us a Top 25 Podcast: https://blog.feedspot.com/regulatory_compliance_podcasts/

The Compliance Guy has been Nominated in 2 categories (Andy Curry Award and The Business Category) for a People's Choice Award. The voting has now opened and if you would, please vote for The Compliance Guy Podcast in the 2 Categories mentioned above! Simply go to this link: https://lnkd.in/grYHk-8P and register then it will take you to the nominations page for you to vote... Once you click on the "Andy Curry" and "Business" categories and you will find "The Compliance Guy" half way down... Click on it, then submit and you are done!